Factors predicting normal visual acuity following anatomically successful macular hole surgery

Matteo Fallico, Timothy L. Jackson, Argyrios Chronopoulos, Lars Olof Hattenbach, Antonio Longo, Vincenza Bonfiglio, Andrea Russo, Teresio Avitabile, Francesca Parisi, Mario Romano, Tito Fiore, Carlo Cagini, Marco Lupidi, Rino Frisina, Lorenzo Motta, Robert Rejdak, Katarzyna Nowomiejska, Mario Toro, Luca Ventre, Michele Reibaldi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)


Purpose: To assess the incidence of normal vision following anatomically successful macular hole surgery and associated clinical variables. Methods: Multicentre, retrospective chart review. Preoperative, intraoperative and postoperative clinical data were extracted from electronic medical records from seven European vitreoretinal units. Inclusion criteria were as follows: eyes undergoing primary vitrectomy for idiopathic full-thickness macular hole from January 2015 to January 2018; postoperative macular hole closure confirmed by spectral domain optical coherence tomography (OCT); preoperative pseudophakia or phakic eyes receiving combined cataract surgery; one-year follow-up. The primary outcome was ‘normal vision’ defined as a final best-corrected visual acuity (BCVA) ≥ 20/25. Univariate, multivariate and decision-tree analyses were conducted to evaluate the clinical variables associated with ‘normal vision’. Odds ratios (OR) and confidence intervals (CIs) were calculated. Results: Of 327 eligible cases, 91 (27.8%) achieved ‘normal vision’ at 1 year. Multivariate analysis identified variables significantly associated with ‘normal vision’: shorter symptom duration (odds ratio [OR]=1.05; 95% confidence interval [CI]:1.02-1.09; p = 0.002), smaller preoperative OCT minimum linear diameter (OR per 100-micron increase = 1.65; 95%CI:1.31-2.08; p < 0.001) and better mean preoperative BCVA (OR = 15.13; 95%CI: 3.59-63.65; p < 0.001). The decision-tree analysis found that the most significant variable associated with ‘normal vision’ was symptom duration. ‘Normal vision’ was achieved in 70.6% of eyes operated within one week from symptom onset and in 45% of eyes with symptom duration between 1 and 3 weeks. Conclusions: These findings suggested urgent surgery is justified for small macular holes of short duration.

Original languageEnglish
JournalActa Ophthalmologica
Publication statusAccepted/In press - 1 Jan 2020


  • full-thickness macular hole
  • idiopathic macular hole
  • macular hole closure
  • macular hole surgery
  • vitrectomy


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